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62 Cards in this Set

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DISPAREUNIA
COGNITIVE-PERCEPTUAL PATTERN. PAINFUL INTERCOURSE THAT CAN BE PARTICULARLY PROBLEMATIC FOR A WOMAN; MAKING HER RELUCTANT TO HAVE SEX.
MENARCHE
1st episode of menstrual bleeding, indicating that the female has reached puberty. usually between age of 12-13 but sometimes earlier.
MENSTRUAL CYCLE
a monthly process mediated by the hormonal activity of the hypothalamus, pituitary gland, and ovaries. occurs each month an egg is not fertilized.
CLIMACTERIC
occurs in men: in their late 40s or early 50's. Decreased levels of androgens cause climacteric. Still capable of producing sperm, but erections are less firm and ejaculation less frequent, and recovery is longer. Also occurs in women: a transitional time in a woman's life marked by declining ovarian function and decreased hormone production. Begins at onset of ovarian decline and ends with cessation of postmenopausal symptoms.
Birth control types that require a health providers intervention
hormonal contraception: oral contraceptive pills, vaginal contraceptive rings,intramuscular injection, subdermal implant, transdermal skin patches, and IUD. Then there's diaphragm, cervical cap, sterilization,
IUD
plastic device inserted by physician into uterus through cervical opening. IUDs vary in shape and some contain copper or progesterone. IUD makes uterus a less favorable place for implantation.Effective= 99-100 % Failure rate=0.6/1.5%; percent. use after 12months=78-81%
Advantages: No memory or motivation needed.Disadvantages:
Cramping, bleeding, expulsion is possible, not recommended if risk for STI.
CERVICAL CAP
Smaller than diaphragm, just covers tip of cervix, maybe more comfortable. Still apply contraceptive cream.
STERILIZATION METHODS
FEMALE: TUBAL LIGATION. involves cutting or tying fallopian tubes. MALE: VASECTOMY: Vas deferens is cut and tied. Both are permanent.
What can lead to dyspareunia?
Means pain with intercourse. Caused by perimenopause or decreased levels of estrogen which lead to diminished vaginal lubrication and decreased vaginal elasticity.
The first 3, 6, 9, or 12 years are crucial in the development of gender identity?
The first 3. The child identifies w/ the parent of the same sex and develops a complementary relationship with the parent of the opposite sex.
Gender roles
Societal rules that decide what role you take if you are male or female.
WHAT STI is associated with infertility?
Chlamydia, which can lead to PID or ectopic pregnancy as well as infertility and neonatal complications.
SEXUAL DYSFUNCTION
THE absence of complete sexual functioning. Common as high as 52% in men and 63% in women. 1 type is erectile dysfunction (ED). Vaginismus: A spastic contraction or tightening of vagina during or before penetration for intercourse. Or orgasmic dysfunction: the inability to achieve orgasm or difficulty attaining orgasm in certain situations.
What is the chemical mediator that causes pain as part of the inflammatory response during menstruation?
Prostaglandins. Can cause back pain and headache as well as stomach cramps. Peaking levels cause symptoms 2 days before to until 2-3 day into period.
What is dysmenorrhea?
a painful menstruation that affects a woman's ability to perform daily activities for 2 or more days a month.
What is PMS?
Premenstrual syndrome is experienced to some degree by 85% of females. Symptoms include irritability, mood, fluid retention, heart palpitations, ...Normal cause is normal fluctuation of estrogen and progesterone, can also be caused by hyperprolactiniemia: excessive prolactin.
What things can nurse implement/intervent for PMS
exercise, eat a balanced diet, sleep, rest, whole grains,vegies, fruits , salt sugar, and caffeine. Sometimes diuretics, oral contraceptives, depressants, antidepressants and vitamins
When is the best time for a testicular exam and what age.
Most common cancer among young men 20-34 years. 2nd most common in men 35-39. and 3rd most common 15-19 yrs. Best time to give self exam is after a shower. It's very treatable.
Endometriosis
AKA retrograde or lining going backwards up through the fallopian tubes and replanting in other tissues lining the pelvis. These lining tissues respond as normal to hormones, and it grows and thickens in these areas too, and when menstration happens they bleed too causing inflammation. This can happen to most women, but in some these tissue misplacements start to form scarring and lesions that lead to endometriosis.
Displasia:
precancerous cells that lead to cervical cancer. 2 kinds of cervical cancer: squamous cell carcinoma and adenocarcinoma. Most are squamous kind. This is why it is important to have a Pap (papanicolaou) smear every year after starting period or after first sexual experience. Primary risk for cervical cancer is HPV human papilloma virus infection. A new vaccine is recommended for girls 9-26 yrs.
Mammography:
digital mammography, and computera ided detection. Converts exrays to electrical signals
Menopause
a term meaning pause or cease. Can only be certain 1 year after menstruation ceases. Average age is 51-52 years. Anywhere from 35-60
Perimenopause
period of time before menopause 2-8 years before. Can be anywhere from age 39-to age 51 years. The average it lasts is 4 years
Symptoms of perimenopause:
irregular menses, hot flashes, vaginal dryness, dyspareunia, and mood changes. Use of oral contraceptives can help with periods, hot flashes and vaginal dryness. Also HRT either estrogen-only(can cause endometrial cancer or breast cancer) or estrogen-progestin (can cause CD, stroke, or DVT) It is said that least risk/greatest bene is within 10 yrs menopause.
Post menopause
starts the day after the year of menopause has been completed. Estrogen is produced solely by the adrenal glands and ovaries are no longer involved in estrogen production.
Because of controversies surrounding HRT or MRT nurses should focus perimenopausal counseling on:
Healthy lifestyle changes: smoking cessation, low-fat, prevention of osteoporosis, other treatments for menopausal symptoms.
What are Leiomyomas and their treatment.
uterine fibroid tumors, B9 growth, from sm.muscle in uterus, mostly after age 50, but sometimes younger or detected in persons with infertility. Treated either with ablation or myomectomy (removal for those wanting to preserve fertility.)
Ovarian cysts
B9 fluid- filled sacs that develop on ovaries and cause pain and at times bleeding. Most often functional.
What is thelarche?
the appearance of breast buds occurring at approximately 9-11 years.It is the first signal that ovarian function has begun.
What is a corpus luteum?
It is the yellow body corpse that remains after the ovum has been expelled from the ovary (ovulation).
What is painful menstruation called?
dysmenorrhea
What is the proliferation stage of menstruation?
Includes end of menses through ovulation (usually days 7-14). Endometrial lining is about 1-2mm thick. Cirucalting estrogen is low to start, but gradually increases , enlarging the endometrial glands and growth of uterine smooth muscle. Vaginal mucosa thickens, and changes in cervical mucous to prepare possible transition of sperm.
Secretory Phase:
Time of ovulation to the period. Just prior to menses; days 15-26. Characteized by increase in progesterone creates highly vascular secretory endometrium suitable for implantation of ovum; endometrial growth ceases and increase of stickiness of cervical mucosa.
Ischemic Phase:
Is from end of secretory phase to onset of menstruation. During ischemia estrogen and progesterone are low which makes spiral arteries constrict, no more blood flow and the blood vessels rupture leading to menses.
Which type of elasticity of cervical mucous means a woman is ready conceive? Thin and watery or viscous?
Thin and watery.
What are the 2 test used for testing cervical mucous to detect ovulation?
spinnbarkheit and ferning.
what is andronarche?
Testosterone continues in the testes, boys grow facial and pubic hair,voice changes, sperm production and closure of long bones
Explain the Reproductive Hormone Cycle
What are the different phases of the menstruation cycle in relation to the ovum maturation cycle and the specific hormones/levels involved. see page 1328 lewis
When does puberty start and why, and what hormones are involved?
No known trigger! Not sure what it is. Gonadotropin-releasing hormone (GnRH): is released from hypothalimus and targets anterior pituitary, which releases 3 other hormones:Follicle-stimulating hormone (FSH),Luteinizing hormone (LH) / ICSH in men, and Prolactin
Girls it happens between 9-17 years
FSH causes release of estrogen
Boys – between 12-14 years
Increased testosterone.
In which of tanner's stages is thelarche?
second stage when breast buds form.
Explain the biophysical changes that happen in older men to the various body parts: penis, testes, prostate, and breasts.
In older men the testes will lose subcutaneous fat, and will lose firmness and refractory period; testes still make sperm forever..but decrease in testosterone, decrease size, and hang lower; prostate: b9 hyperplasia and enlargement; breasts: enlargement.
Explain the biophysical changes that happen in older women to the various body parts: vagina, breasts,vulva, uterus, ovaries...
Breasts:Decreased subcutaneous fat, increased fibrous tissue, decreased skin turgor,less resilient, looser, more pendulous tissue; decreased size; duct around nipple may feel like stringy strand;Vulva:
decreased skin turgor,atrophy; decreased amount of pubic hair; decreased size of clitoris and labia
Vagina:atrophy of tissue, decreased muscle tone, pH becomes alkaline
pale and dry mucosa; relaxation of outlets; mucosa thins; vagina narrower and shorter; increased potential for infection;Urethra
decreased muscle tone, cystocele (protrusion of bladder through vaginal wall);Uterus:decreased thickness of myometrium,decrease in size; uterine prolapse
Ovaries:decreased ovarian function,
nonpalpable ovaries; decreased size.
What are some common nurse diagnoses when it comes to reproductive health?
Disturbance in body image related to early development of secondary sex characteristics: (females, 9 yr old); Health seeking behaviors related to reproductive functioning: (people trying to get pregnant);
Pain related to uterine cramping from menstruation; Sexual dysfunction related to as yet unknown cause:(elderly, could be a medicine, anyone could have or sexual identity issues); Anxiety related to fear of contracting an STI: (sexually transmitted infection)
Examples of Nurse plans related to reproduction are:
1)Help client understand normal processes:(girl that has period the first time, people who haven’t been educated, let them know it’s normal. Boys having wet dreams. We may be the only person to tell them what is normal.); 2) Health teaching to prevent or mitigate (lessen) discomfort or anxiety with: Menstruation,Menopause,Erectile dysfunction, and Dyspareunia: painful intercourse; 3)Instruction in health promotion actions: self breast exams, self testicular, going to doctor dre digital rectal exam, pap smears, proper use of birth control.
Examples of Nursing Implementations/interventions related to reproduction are:
1) Encourage female clients to have mammograms: self is good, but mammogram can show very small things, especially with family history.2) Self testicular exams for young males because of testicular cancer.3) Teach clients by using diagrams, videos or pictures on sexual health: 4) Provide discrete discussions on STIs, safe sex practices, sexuality, normal functions to clients: Don’t stand in hallway that says you have herpes, safe sex: condoms, etc. sexuality: I’m taking care of the transvestite down the hall, make it discrete.
What are example of nursing evaluations that are related to reproductive health?
1) Evaluates if client states changes made.Client states ablility to manage symptoms of premenstrual dysphoric symptoms (PMS): or Client states understanding of normal deviations in age with puberty or client states has been performing self testicular exam every few months.If you get client’s confirmation then they have been evaluated; can’t prove, but they can confirm, which means they have been evaluated.
What are the 4 common problems related to menstruation and common remedies for each?
1) Premenstrual syndrome (PMS): can be psychological, anxiety, depression, helps to decrease salt, carbs, and caffeine, encourage exercise, decrease stress, is normal, but unexpected, can last many days causing irritability.
2) Dysmenorrhea: painful bleeding; causes can be: excessive prostagladins, or other conditions. Ibuprofin helps. Metlshmirtz: ovulation pain. Normal, but unexpected. Endometriosis: can be normal have retrograde bleeding that exacerbates pain because bleeding is happening in many areas. Use painkillers, nonsteroidal naproxen, exercise, contraceptives.
3) Irregular bleeding – Menorrhagia: Excessive bleeding from longer bleeding time or heavier bleeding all at once, either will equal more than usual blood loss, sometimes leioyomas can be the cause.
Metrorrhagia: spotting or break-through bleeding between menstrual periods. Many causes from birth control to carcinoma, to polyps
Name the 3 parts of cessation of menstruation and describe the first part only.
There are 3 stages involved in menstruation cessation: Perimenopause, Menopause and Postmenopause. Stage 1)
Pre or Peri-menopause: Changes in periods: maybe lighter or heavier, or irregular; Hormone fluctuation: out of wack, vasomotor instability (hot flashes from decreasing estrogen); Increased coronary artery disease related to decreased estrogen & osteoporosis; Disuria: pain with urination, mood changes, can be mild or severe, usually normal Peri menopause lasts 2-8 years, ranges in years of age 39-51. Usually it lasts around 4 years on average. Physiologically means increases and decreases of progesterone and estrogen at uneven levels causing the menstrual cycle to become longer, shorter and eventually absent. Can include hot flashes, vaginal dryness (causes dispareunia-painful intercourse) and mood changes. Can use hormonal therapy, but there are contraindi-cations that can lead to diseases.
HRT: estrogen only: can cause cancerEstrogen/progesterone: can cause stroke, heart attack and Dvt
Nurses can promote: Healthy lifestyle changes: stop smoking, eat right, limit salt, and alcohol
Prevent osteoporosis< Drink milk, take vitamin D, calcium, Weight bearing exercise, etc….Climacteric Phase: is the decline of ovarian function, and associated loss of estrogen and progesterone production.
What are some non-hormonal/ and hormonal treatments for peri or postmenopause?
Nurses suggest: Non-hormonal: cool environment, loose fitting clothing, less caffeine, relaxation, vitamin E, kegel, weight bearing exercise, Vitamin D, nutritious diet: limit salt and alcohol, no smoking, KY jelly, water-based for vaginal dryness.
Hormonal: HRT, Talk to doctor. Estrogen-dependent cancer. Can also take testosterone. Reason for hormones: relieves symptoms.
Hormonal: But don’t do if someone smokes, cardiac, liver or kidney issues
If you don’t have a uterus you take estrogen; if you have a uterus you need estrogen and progesterone.
What are some nursing interventions regarding menopause?
1) Educate peri-menopausal women on changes and symptoms
2) Present menopause as a natural change and that symptoms are temporary
3) Stress non-hormonal treatments for problem symptoms
4) Correct misunderstandings of menopause
What is it called when men are climacteric and what are the symptoms and treatments?
Andropause:Men get decrease of testosterone over time. Decrease may cause symptoms or not.
Need blood test to confirm lower testosterone.Some signs and symptoms: swollen breasts, smaller testes, decreased energy , sleep problems, increased body fat, loss of pubic hair….,depression.
Treatments – possible testosterone replacement therapy, herbal supplements: salt palmeto,) eat right, stay active and seek help for depression.
When should women start clinical breast exams and mammograms?
Breast health:Clinical breast exam
At least every 3 years starting in your 20s; Mammogram (x-ray of breast)Every 1–2 years. Discuss with your doctor or nurse.
List the steps of a self breast exam.
Remember! Don't lift fingers and breast tissue can continue into armpit. 1) Visually inspect breast in mirror: color, contour, shape and size, dimpling, puckering, nipple direction, redness, rash, or swelling
2) Repeat with arms slightly raised above head.
3)Inspect and palpate nipple, squeeze for discharge.
4) Palpate breast and axillae, recline on bed w/pillow under each shoulder, Use left hand for right breast &vv. Use 3 finger pads to palpate entire breast, use overlapping dime-size circular motions w/3levels of pressure: light for skin, medium deeper, and firm for close to chest & ribs.
5) Repeat steps standing or sitting.
6) best after a period.
Clinical breast exam: done at the doctor. every 3 years for 18-39
Every year for 40 +
Diagnostic testing: start with mammo, then to ultrasound, then a biopsy.
Mammogram: exposure to small dose of ionizing radiaiton, digital and Cad
Every year after age 40
What are the 6 benign Breast disorders?
1) Mastalgia: Pain; 2) Mastitis: inflammation: milk duct infection, red inflamed, hot and probably under the breast. 3) Fibroadenoma: B9tumor: common in younger women, small, movable, BB-marble, fibrous tissue. Should be firm, moveable, painless, rubbery; 4) Fibrocystic changes: fluid-filled cysts, extra lumpy also b9, hormonal, seen as almost a normal
5) Ductal Ectasia: inflammation around nipple, bloody discharge or antibiotics. Could be painful or not.In some women who are pre– or peri-menopausal (age 40 – 50), breast milk ducts may become swollen and clogged. Milk ducts can dilate (swell) and the walls may thicken, so much so that the flow of fluid is blocked. These ducts are just beneath the nipple, and when these swell, that can cause your nipple to feel tender or irritated, and may cause nipple discharge. Mammary duct ectasia can cause grey to green discharge that is thick and sticky. This is a benign (non-cancerous) condition.What Duct Ectasia Feels Like.Duct ectasia can feel like a small lump just under your nipple. The nipple and areola may become tender and irritated, and turn pink or red. You will see thick, sticky discharge from your nipple. This discharge is benign, and can be black, grey or greenish in color. This means you have an infection within a duct. In some cases, your nipple may retract (pull inwards) during a bout with duct ectasia. Once the condition resolves, your nipple should return to normal. 6) Intraductal Papilloma: wart-like growth near nipple, discharge might be bloody, might or might not be cancer. Intraductal papilloma is a tiny wart-like growth in breast tissue that sometimes punctures a duct. These benign tumors are composed of fibrous tissue and blood vessels. Intraductal papillomas grow inside your breast's milk ducts, and can cause benign nipple discharge.
What are the b9 tumors found in the lower half of the woman's body?
1)Leiomyomas: usually in uterus: fibroid tumors,
2)Cervical polyps: growths that attach around cervix, want to get rid of them
3)Ovarian cysts: develop in ovaries
Where are the 3 places in the uterus that leiomyomas are found?
1) Subserous, 2) submucous 3) Intramural.
What are the important things to know about testicular cancer and the testicular exam?
Used to check for any unusual lumps or bumps. Best to do after a hot shower. Normally left testicle is lower than right. Gently roll each testicle between fingers looking for pea or rice size painless lumps which are abnormal. Notice any swelling changes in size or color of testicle or scrotum.Note any pain or achy areas in groin. Statistics: Although testicular cancer is unusual in teen guys (it occurs in 3 out of 100,000 guys between the ages of 15 and 19 in the United States), it is the second most common cancer seen during the teen years. It is the most common cancer in guys 20 to 34 years of age.
What are common health screenings for the various age groups and genders?
18-39 years old: examination, testicular, clinical too, pap, breast exam, immunizations, HIV, STI, dentists, chlamydia important,
40-49 years old: mammogram, blood pressure, cholesterol, Pap, STI, thyroid, blood glucose, type II diabetes, pelvic, HIV.
50-65 years old: colorectal, prostate, STI osteoporosis, Direct rectal exam: prostate, Type II occult blood and colonoscopy for colon cancer blood pressure, mammogram, cholesterol, flu vaccine, bone scan
65 years or older: osteoporosis, and pneumo-vaccine. colorectal, prostate, STI osteoporosis, Direct rectal exam: prostate, occult blood and colonoscopy for colon cancer blood pressure, mammogram, cholesterol, flu vaccine, varicella for shingles.
All of these depend on family history.
Actual methods aside, what are the basic educational principles to consider in regards Family Planning.
Need to remember the basics: 1) Multiple methods are available, but
Most are designed for women: 2)
Most need a commitment to use- can’t take it one day and then not the next. 3) None are 100% effective except total abstinence.
4) Education in any form of birth control is needed: ALWAYS EDUCATE WHEN YOU GIVE.
5) Remember to consider: cost, availability, preference, culture, religious and personal beliefs all will influence method chosen. Remember that we are the educators and counselors so we need to stay knowledgeable on current methods. Need to remain comfortable in teaching and demonstrating methods. Remain able to focus on patient’s needs and preferences for birth control.
What are the waves of the future in birth control?
Emerging methods: Chemical barriers, contraceptive microbicide and attachment of disease from attaching. Hormonal transplants: Jdel in europe, transcervical sterilization, and essure: stint a tube put into metal piece put into fallopian tubes to cause scarring to prevent pregnancy. Ectopic pregnancy, immuno-contraceptives, vaccines that inhibit reproductive process, fertility computers: put in info, male contraception to maybe reduce sperm count, vas deferen electrical current to immobilize sperm. Sperm blocking gels.
Describe stage 2 in cessation of menses.
Stage 2 is Menopause: it is 1 day: means achieving 12 months of no bleeding. A hysterectomy is a surgically induced menopause. Will need HRT. Chemotherapy, radiation, or smoking can make menopause arrive early.
Describe stage 3 in cessation of menses.
3) Post-menopause: Life after menopause, might get occasional hot flashes: stress incontinence and osteoporosis is more common.During post-menopause estrogen is only produced in the adrenal glands and the ovaries are no longer involved in estrogen production. Loss of estrogen is associated with lower HDL and higher LDL promoting CD. And also no estrogen promotes osteoporosis.